Breast Cancer Related Lymphoedema

1 in 8 women will be diagnosed with breast cancer during their lifetime1

There were around 55,200 new cases of breast cancer in the UK in 20151

Cancer survival has doubled in the last 40 years1

As the survival rate of breast cancer patients increases so does the incidence of BCRL. These conditions can become progressive if not diagnosed quickly and can have a significant impact on the patient's quality of life and the NHS.2

BCRL affects approximately 20% of patients treated for breast cancer, although the true impact may be greater as this does not take into account lymphoedema of the breast and torso.

BCRL results from a failure of the lymphatic system due to:

Surgery

Radiotherapy

Infection

Chemotherapy

Obesity

Patients treated for breast cancer often report:

Being unaware that lymphoedema was a possible outcome of cancer treatment

Healthcare professionals were not well informed and / or not helpful in guiding them on how to reduce the risk of lymphoedema

Being unaware that lymphoedema can also develop in the breast, chest wall or back as well as the arm

Limited support on how to manage this debilitating chronic condition

Treatment considerations

Seroma

Fibrotic / hardened tissues

Palliative care

A lifelong chronic condition

Lymphoedema results from a failure of the lymphatic system. Consequences are swelling, skin and tissue changes and a predisposition to infection. It most commonly affects the lower or upper limbs, but may also affect midline structures such as the head and neck, trunk, breasts or genitalia.3 Research shows that lymphoedema affects between 1.33 and 3.99 per 1,000 population.4

Due to the high maintenance nature of lymphoedema and the impact on the immune system the risk of developing cellulitis is the most common side effect of lymphoedema. Cellulitis is a costly condition often requiring hospital admission.

NHS Choices state: “In England in 2009, around 80,000 people were admitted to hospital as a result of cellulitis. The number of annual cases of cellulitis has increased three-fold over the past 15 years”.5

The cost of hospital admission in a one year period, for the treatment of cellulitis in three counties with a population of 2.5 million, was approximately £4.1 million.5 It has been shown that the average hospital stay for cellulitis associated with lymphoedema was approximately 12 days and incurred an estimated cost of £2,300 per patient.4

More than £178 million per year was spent on admissions in the UK, due to complications from lymphoedema, with a rise in costs of £7 million from 2013 to 2014, equating to more than 22,904 additional admissions.6

Recent research by McMillian Cancer Support has shown that for every £1 spent on the management of lymphoedema, the NHS will save approximately £100.6

Impact of lymphoedema

Lymphoedema can be one of the most dreaded and unfortunate outcomes of breast cancer treatment. Currently, there is no cure for this chronic condition. This creates a very distressing and upsetting situation, where patients having survived breast cancer are forced to live with a life-time risk of developing or living with lymphoedema.7

Research outlined in the ‘Commissioning Guidance for Lymphoedema Services for Adults Living with and Beyond Cancer’ and carried out by Christine Moffat outlines the impact of lymphoedema to both the patient and the NHS due to complications associated to lymphoedema.8

80% of people with lymphoedema required time off work

50% of patients with lymphoedema experienced recurrent episodes of cellulitis

50% of patients reported uncontrolled pain

33% of people had not been told they had lymphoedema

36% of people had received no treatment for their condition

29% had cellulitis in the preceding year

27% of those with cellulitis required hospital admission for intravenous antibiotics and the mean hospital stay was 12 days

Improved awareness, diagnosis and prompt treatment of lymphoedema can minimise treatment costs and importantly improve outcomes and experience for people living with lymphoedema.